Neuro deck Flashcards
1
Q
What are the components of the scalp, and why do open wounds here tend to bleed extensively?
A
The scalp is composed of the skin and soft tissues covering the skull. It has a rich blood supply, causing open wounds to bleed extensively.
2
Q
How should bleeding from a scalp wound be managed?
A
Bleeding from a scalp wound usually responds to direct pressure. If bandaging is required, ensure appropriate cervical spinal motion restriction is applied for patients with suspected cervical injuries.
3
Q
What is the significance of swelling in closed scalp wounds, and how should it be treated?
A
Closed scalp wounds may swell rapidly due to bleeding underneath the scalp. Swelling responds best to ice packs if available.
4
Q
What are the two main types of skull fractures, and how are they identified?
A
Skull fractures can be linear or depressed. Linear fractures appear as straight lines on X-rays, while depressed fractures are caused by localized force, resulting in a segment of the skull being buckled inward.
4
Q
Why must all patients with a soft-tissue injury to the scalp be assessed for cervical spine injury?
A
Because of the potential for cervical spine injury associated with head trauma, spinal motion restriction should be applied accordingly.
5
Q
What is the difference between open and closed skull fractures?
A
A closed-skull fracture occurs without a break in the skin, while an open-skull fracture is associated with a scalp laceration.
6
Q
What are basilar skull fractures, and how are they detected?
A
Basilar skull fractures involve the bony plates at the base of the skull and cannot be detected directly. They often require CT scanning for diagnosis and are identified by specific signs such as cerebrospinal fluid leakage, Battle’s sign, and raccoon eyes.
7
Q
List the signs of a basilar skull fracture.
A
Signs include clear fluid (cerebrospinal fluid) leaking from the nose or ear canal, bleeding from inside either ear canal, bruising and swelling behind the ear (Battle’s sign), and bruising around both eyes (raccoon eyes).
8
Q
What is a cerebral contusion, and what can cause it?
A
A cerebral contusion is the bruising of brain tissue, often caused by a direct blow to the head. It can result from the brain shifting and impacting the opposite side of the skull (contrecoup injury).
9
Q
Describe subdural and epidural hematomas and their typical causes.
A
Subdural hematomas are caused by venous bleeding below the dura mater, while epidural hematomas are caused by arterial bleeding above the dura mater, usually after a head injury. Both are life-threatening and often require emergency surgery.
10
Q
What is a concussion, and what are its common symptoms?
A
A concussion is a mild form of brain injury causing a brief “short circuit” of the brain. Symptoms include headache, dizziness, nausea, confusion, and memory problems.
11
Q
Why is it important to monitor the level of consciousness in patients with brain injuries?
A
Changes in the level of consciousness can indicate the severity and progression of brain injury. It’s important to track whether the level of consciousness is improving or deteriorating.
12
Q
What must be assumed about any patient under the influence of drugs or alcohol who has sustained head or face trauma and has an altered level of consciousness?
A
They must be assumed to have sustained a brain injury until proven otherwise.
13
Q
Why is pupil size and response to light important in assessing brain injury?
A
The nerve pathways controlling pupillary response travel from the eyes into the skull and down to the brain stem, and they are sensitive to changes in intracranial pressure.
14
Q
What happens if intracranial pressure exceeds a critical point?
A
The brain stem becomes compressed, which can be fatal.
15
Q
What does a dilated and sluggishly reactive or fixed pupil indicate in a patient with decreased consciousness?
A
It indicates severe brain injury with probable increased intracranial pressure.
16
Q
How can direct trauma to the eye be differentiated from severe head injury?
A
Patients with direct eye trauma are usually alert and have a normal level of consciousness, unlike those with severe head injury.
17
Q
What should an OFA attendant look for during the examination of the head?
A
Signs of a basilar skull fracture and evidence of a depressed skull fracture.
18
Q
What does asymmetry of movement or sensation between the left and right sides of the body indicate?
A
A severe brain injury.
19
Q
What are the complications of brain injury that an OFA attendant should be aware of?
A
Convulsions (seizures) and vomiting.
20
Q
How should vomiting be managed in a patient with a brain injury?
A
Log-roll the patient into the lateral position while maintaining cervical spine motion restriction, clear the airway, and reposition the patient supine.
21
Q
What is a stroke (CVA)?
A
A cerebrovascular accident causing brain damage by the sudden blockage or rupture of a cerebral artery.
22
Q
What are the two main types of strokes?
A
Ischemic strokes and hemorrhagic strokes.
23
Q
What causes ischemic strokes?
A
Blockage or narrowing of a cerebral artery, often due to atherosclerosis or embolism.
24
What causes hemorrhagic strokes?
The rupture of a cerebral artery, often at weakened regions of the vessel wall due to atherosclerosis or high blood pressure.
25
What are some general signs and symptoms of a stroke?
Weakness or loss of use of limbs, severe headache, nausea, confusion, visual difficulties, dizziness, unequal pupils, and changes in vital signs.
26
What does the mnemonic FAST stand for in stroke screening?
Face (look for droop/asymmetry), Arms (check for dropping), Speech (assess speech), Time (act quickly).
27
What is the first step in the management of a stroke patient?
Conduct the scene assessment and activate emergency response procedures.
28
What should be done if a stroke patient has a decreased level of consciousness?
Ensure an open airway, insert an oropharyngeal airway if needed, provide assisted ventilation, suction the airways, and transport the patient to a medical facility.
29
What are seizures and what causes them?
Seizures are a massive discharge of electrical impulses from the brain cells, caused by various conditions such as epilepsy, head injury, hypoglycemia, and more.
30
What is status epilepticus?
A prolonged seizure lasting more than 20 minutes or successive seizures without regaining consciousness, which is a life-threatening emergency.
31
What is the Priority Action Approach to a patient with a seizure?
Maintain airway, protect from injury, position laterally, loosen clothing, avoid forcing objects into the mouth, provide oxygen, and suction if needed.
32
What is the most common cause of spinal fractures and spinal cord injury?
Motor vehicle crashes, even when seat belts are worn.
33
Why are whiplash injuries common in motor vehicle crashes?
ecause the force of impact can cause muscle and ligament strains of the neck and potentially cervical spinal fractures.
34
What type of accidents increase the likelihood of spinal fractures, especially if seat belts are not worn?
Crashes involving bicycles, motorcycles, all-terrain vehicles (ATVs), and other mobile equipment.
35
How does the height and manner of a fall impact spinal injury?
Higher falls and the manner in which the body strikes the ground can determine the type and location of spinal injury, such as fractures of the lower thoracic or upper lumbar vertebrae from landing on the feet.
36
What should an OFA attendant suspect if a patient falls down a flight of stairs?
The patient is at risk of spinal injury, especially to the cervical spine.
37
What types of direct blows to the spine can cause spinal fractures?
Assaults, crush injuries, and blunt injuries from falling or swinging objects.
38
Why is diving into shallow water a common cause of cervical spine fracture?
The impact with the bottom can result in cervical spine fractures, especially in near-drowning victims in shallow water.
39
What sports are considered high-risk for spinal fractures?
Football, rugby, hockey, and gymnastics.
39
How can gunshot and penetrating injuries impact the spinal column or spinal cord?
They may directly injure the vertebral column or the spinal cord.
40
What type of injuries can severe electric shock cause?
Direct spinal cord injury or spinal fractures from violent muscle spasms.
41
Why should facial and head injuries raise suspicion of cervical spine fracture?
The same mechanism of injury that causes facial or head damage can also cause cervical spine fractures.
42
What are the different types of spinal injuries?
Spinal cord injury, spinal nerve injury, vertebral fractures and/or dislocations, injuries to the intervertebral discs, strains and/or sprains of the back or spine, or a combination of these.
43
Can spinal injuries occur independently of spinal cord injuries?
Yes, spinal injuries and spinal cord injuries are different entities and may occur independently.
44
What risk does moving a patient with a vertebral fracture pose?
It may cause significant displacement of the fracture, resulting in permanent spinal cord or spinal nerve injury.
45
What percentage of multiple-trauma victims have cervical spine injuries, and what percentage of these have a spinal cord injury?
Approximately 2 to 4% have cervical spine injuries, of which 5 to 15% have a spinal cord injury.
46
What can cause an incomplete spinal cord injury to worsen?
Swelling, bleeding, or inappropriate handling of the patient.
47
How do complete and incomplete spinal cord injuries differ?
Complete injuries result in total loss of motor and sensory functions below the injury level, while incomplete injuries result in partial loss.
48
What is a possible physical finding in male patients with spinal cord injury?
Persistent erection of the penis (priapism).
49
What commonly causes spinal nerve injuries?
Conditions that cause narrowing of the bony passageways through which spinal nerves pass, such as fractures, arthritis, or intervertebral disc protrusions.
50
What are common findings in patients with spinal nerve injury?
Pain and partial loss of sensation and motor strength in one extremity.
51
What is the difference between stable and unstable vertebral fractures?
Stable fractures are not at risk for displacement, whereas unstable fractures can cause spinal cord or nerve injuries if moved.
52
How can intervertebral discs be injured?
They can be injured suddenly or deteriorate over time, often due to heavy lifting or long-haul truck driving.
53
What is a disc herniation and what does it cause?
A bulging of the disc or its nucleus that can pinch the spinal nerve or spinal cord, often referred to as a "slipped disc."
54
What are common causes of muscle strains or ligament sprains in the back?
Overloading, overuse, or stretching beyond normal range, such as lifting heavy objects or sudden twists.
55
Why must the OFA attendant rely on the mechanism of injury in some patients?
Patients with other serious injuries, intoxication, or drug influence may not notice spinal pain.
55
What are the risk factors for muscle or ligament strains of the back?
Previous back injury, overloaded muscles or ligaments, overuse or misuse, poor muscle tone, and poor posture.
56
What symptom is a conscious patient likely to report with spinal injury?
Pain or stiffness in the affected area of the spine.
57
What should an OFA attendant avoid doing with a patient who indicates pain on spine movement?
Asking the patient to move unassisted.
58
What indicates a possible spinal fracture when palpating the spine?
Tenderness over the bony projections or muscles alongside the spine.
59
What symptoms in extremities suggest a spinal cord or spinal nerve injury?
Numbness, tingling, or weakness.
60
Is the presence of swelling or deformity common with spinal injuries?
No, swelling is unusual and deformity is rare.
61
What should be done for fully conscious patients with mechanisms of traumatic spinal injury and pain in the spinal region?
Assume a spinal fracture and restrict spinal motion.
62
What initial steps should be taken for a patient suspected of having a traumatic spinal injury?
Conduct a scene assessment, open and assess the airway with cervical spine motion restriction, ensure adequate breathing, assess circulation and control severe hemorrhage, and complete the primary survey.
63
What history should be taken to determine if a spinal injury exists?
Ask about pain or stiffness in the neck or back, numbness, tingling, or weakness in extremities, and consider the mechanism of injury.
64
What examination should be conducted for a patient suspected of having a spinal injury?
Head-to-toe examination, palpation of the spine, and a neurological examination to check for weakness, paralysis, or sensory abnormalities.
65
What respiratory difficulties may arise in patients with cervical or upper thoracic spinal cord injuries?
Paralysis of chest wall muscles leading to shallow respiration and decreased ability to clear secretions.
66
What should be assumed if a high cervical spinal cord injury patient is unresponsive and not breathing normally?
Assume the patient is in cardiac arrest and initiate CPR.
67
What are the primary goals in the treatment of spinal injuries?
The primary goals are to prevent further injury, restrict spinal motion, and maximize patient comfort.
68
How should you realign the spine when a spinal injury is suspected?
Realign by slowly and gently rotating to the anatomical position. Stop if met with resistance and support in the position of greatest comfort.
69
How should the patient's head, neck, and trunk move during a roll?
The head, neck, and trunk should move as a unit.
70
Why should the transport stretcher be well-padded?
To prevent pressure sores as the spinal-injured patient cannot reposition limbs and small irritants can cause pressure sores.
70
What should you do if you cannot prove the patient has normal blood oxygen saturations?
Provide oxygen by mask.
71
How can you prevent hypothermia in a spinal injury patient?
Keep the patient warm with blankets.
72
Should a patient with a spinal injury be given anything by mouth?
No, do not give the patient anything by mouth.
73
How should you move a patient with a spinal injury to prevent further injury?
Move the patient as a unit at all times, and ensure spinal stability even during rapid movement for life-threatening emergencies.
74
What should you do if a stretcher is readily available?
Move the patient directly onto the stretcher using a scoop-style stretcher to avoid moving the patient again later.
75
What should you explain to a conscious patient before moving them?
Explain what will happen to ensure the patient’s relaxation and cooperation.
76
What is the preferred position for a patient with suspected spinal injury, and why?
The supine position is preferred because patient assessment and monitoring are easier, and restricting movement of the head and neck is simpler.
77
How is the anatomical position of the spine defined?
A straight line from head to toe without flexion, extension, or rotation, with the head positioned so that the eyes are forward and the chin is in the midline.
77
What should you do if resistance is met during the realignment of the spine?
Stop and do not forcefully rotate the neck. Stabilize and manage spinal motion restriction in the position found.
78
When realigning the spine, what is the neutral position of the head?
The eyes looking straight ahead, perpendicular to the axis of the body.
79
How should you fill the gap between the head and the flat surface the patient is lying on?
Fill the space with padding without moving the head from the neutral position.
80
Under what circumstances should patients with suspected spinal injuries be maintained in the lateral position?
Patients with facial injuries and active bleeding, active vomiting, decreased level of consciousness, stretcher limitations, and helicopter evacuations.
81
What is the first step in aligning a patient’s spine?
Manually stabilize the patient’s head and neck by placing hands on either side of the head over the ears.
81
How should you instruct an assistant when realigning a twisted or rotated trunk?
Have the assistant grasp the patient's waist and gently slide or pull the trunk into the anatomical position
82
What additional support should be provided after placing a hard cervical collar?
Place supports on either side of the head such as head-beds, sandbags, or other suitable materials.
83
What is the first step in log-rolling a prone patient to a supine position?
Take a position at the head of the prone patient and kneel to achieve the necessary control of the patient’s head and neck.
84
How should the head and neck be supported during a log-roll?
Support the head and neck with forearm and hand, and direct assistants to roll the patient as a unit to the lateral position.
85
What should you do if you must quickly drain a patient’s airway and helpers are not available?
Perform a single-person log-roll by kneeling beside the patient, placing one hand at the side of the head and neck, and rolling the patient against your thighs in one smooth movement.
86
How should the patient’s leg be positioned during a single-person log-roll?
Position the patient’s leg to prevent rolling fully prone and maintain the head in line with the cervical spine.
87
What is the first step when managing a patient found on uneven ground or in an awkward position?
The first step is to manually stabilize the patient's head and neck by grasping the trapezius muscle on one side of the neck and the head and face with the other hand.
88
How many assistants are usually required to move a patient from uneven ground to a level surface?
The OFA attendant will usually require at least three assistants, and two additional assistants may be needed to hold and stabilize the stretcher.
89
What should you do if the patient is conscious when found on uneven ground?
If the patient is conscious, ask him or her not to move and explain briefly what will happen next.
90
What is the role of the assistant who holds the patient's legs when moving a patient from uneven ground?
The assistant should straighten and free up the patient's legs and then hold the patient's knees together.
91
In what situations should the OFA attendant extricate a patient from a vehicle without following any protocol?
In extremely dangerous situations, such as fire or rising water, the patient and OFA attendant may be exposed to very high risk, necessitating a rapid extrication without following standard protocols.
92
What is the first step in extricating a patient with a suspected spinal injury from a vehicle?
The first step is to manually stabilise the patient's head and neck in the neutral position with them sitting upright, and then begin the primary survey.
93
When should a spine board be used to extricate a patient from a vehicle?
A spine board should be used when the scene assessment/primary survey reveals a life-threatening situation that requires quick extrication from the vehicle.
94
How should a helmet be removed from a patient with a suspected spinal injury?
The helmet should be removed by realigning the patient's head to the neutral and anatomical position, having an assistant undo or cut the chinstrap, and then carefully widening the helmet to clear the ears and remove it without hyperextending the neck.
94
What is the only effective technique currently available for restricting motion of the cervical spine?
The only effective technique is applying a hard collar and placing supports on either side of the head, then securing the patient on a well-padded stretcher.
95
Why should spine boards not be used for long-distance transports?
Spine boards should not be used for long-distance transports to prevent pain and/or pressure sores. Patients should be transferred to a well-padded stretcher as soon as possible.
95
What is the key measurement used for sizing a hard collar?
The key measurement is the distance between the top of the patient's trapezius and a line from the bottom of the patient's chin to the floor.
95
What are the general guidelines for selecting a hard collar for use at a workplace?
The hard collar must support the weight of the head in the neutral position, limit lateral and rotational movement of the head and neck, not cause airway obstruction, and be translucent for X-ray examination.
96
How should a patient be positioned onto a spine board from supine to supine?
The patient should be rolled into the lateral position, a padded spine board positioned close, and then the patient rolled onto the spine board with care to ensure no wrinkles or bunching of blankets.
97
What must be considered when securing a patient to a spine board for transport?
Ensure the patient is secured to prevent movement, provide maximum comfort, remove hard objects from pockets, and use padding to prevent pressure sores and discomfort.
98
How should the head and neck be secured on a spine board?
The head and neck should be secured last with padding or rolled blankets on either side of the head, and a Velcro strap across the forehead and around the padding and board to restrict cervical spinal motion.
99
What should be used as a pad between the strap and the patient's forehead when securing a patient's head on a spine board?
A dry gauze dressing.
100
In what conditions might tape not stick to the bottom of the spine board when securing a patient?
Cold or wet conditions.
101
Where should securing ties hold the patient's arms during spinal injury management, and why?
The securing ties should hold the patient's arms to their body rather than to the device to allow for easier pulse monitoring and intravenous therapy if needed.
102
Why is sufficient padding under the patient's head important when securing a spinal injury patient?
To ensure the head is not pulled downward and out of alignment when secured.
103
Where should extra padding be placed when securing a spinal injury patient?
Extra padding is required behind the patient's head, in front of the patient's pelvis and thighs, and in the hollow at the waist.
104
What critical interventions might an OFA attendant need to delegate to assistants?
Assisted ventilation with a pocket mask or other critical interventions.
105
Why must an OFA attendant frequently recheck the effectiveness of treatments rendered by assistants?
To ensure the patient's condition does not deteriorate without appropriate intervention.
106
What should an OFA attendant do if they need to focus on critical interventions like airway management or hemorrhage control?
Delegate packaging procedures to others, supervise from the head, and check all strapping and padding once critical interventions are concluded.
107
Why is it important to keep spinal cord injury patients warm?
They are at risk for hypothermia
108
Why must spinal cord injury patients be removed from the spine board whenever possible?
To prevent pressure sores.
109
How often should spinal cord injury patients be turned to prevent pressure sores?
Every 2 hours.
110
What is a pressure sore and how can it develop?
A pressure sore is an injury to the skin and underlying tissue caused by prolonged pressure, particularly over bony prominences, and can develop in as short a time as an hour.
111
What are the potential consequences of pressure sores in spinal cord-injured patients?
They may become large infected ulcers that extend down to the bone and often require surgery with skin grafts to heal, significantly causing morbidity and mortality.
112
What precautions should the OFA attendant take to prevent pressure sores in patients with spinal cord injury?
Remove hard objects from under the patient, ensure the stretcher or spine board is well padded and smooth, and rotate the patient slightly every 2 hours.
113
What is the best first aid approach for spinal injuries?
Always think about spinal injury during patient assessment and treatment, use correct techniques for spinal realignment and immobilization, and take extra care to prevent complications.
114
What are the non-emergency concussion signs and symptoms?
Thinking and remembering:
- Not thinking clearly
- Feeling slowed down
- unable to concentrate
- memory problems
Physical:
- Headache
- Fuzzy or blurry vision
- Nausea and vomiting
- Dizziness
- Sensitivity to light or noise
- Feeling tired or having no energy
Emotional and mood:
- Easily upset or angered
- Sad
- Nervous or anxious
- More emotional
Sleep:
- Sleeping more/less than usual
- Trouble falling asleep
115
What are the emergency concussion signs and symptoms?
You see:
- Repeated vomiting
- Seizure or convulsion
- Deteriorating or loss of consciousness
Patient complains of:
- Neck pain
- Double vision
- Weakness or tingling/burning in the arms/legs
- Severe or increasing headache
Patient is showing
- Unusual behaviour
- Increasing confusion or irritability
116
How should you manage a patient showing non-emergency signs of a concussion?
1. Perform scene assessment
2. Perform primary survey
3. Once you've identified they have the non-emergency signs and symptoms of a concussion:
* Don't send patient back to work
* Send patient to a qualified health care professional or hospital
4a) If patient returns to work within 24 hours post-injury, follow up with the patient over a two-day period when they return to work
4b) If a patient returns to work greater than 24 hours post-injury, follow up as necessary according to protocol
117
How should you manage a person who sustained a concussion that had the non-emergency signs and symptoms that returned to work within 24 hours post-injury?
Follow up with the patient over a two-day period when they return to work
118
How should you manage a person who sustained a concussion that had the non-emergency signs and symptoms that returned to work greater than 24 hours post-injury?
Follow up as necessary according to protocol
119
How should you manage a patient showing emergency signs of a concussion?
1. Perform scene assessment
2. Perform primary survey
3. Once you've identified they have the emergency signs and symptoms of a concussion, refer them to medical aid immediately
120
How should you manage a patient with a suspected concussion that is not showing any of the signs or symptoms?
1. Perform scene assessment
2. Perform primary survey
3. Assess whether they are high or low risk for re-injury in the work place
3a) If high risk:
* Don't send patient back to work
* Send patient to a qualified medical professional/hospital to avoid re-injury
* When patients returns to work, follow up with patient over a 2 day period
* Inform patient and employer of potential concussion symptoms and red flags
3b) If low risk:
* Send patient back to work and follow up with patient over 2 day period
* Instruct patient to report to OFA attendant on site if symptoms arise
* Inform the patient and employer of potential concussion symptoms and red flags
121
When may concussion be suspected?
If the patient experienced a direct blow to the head, neck, face, or a hard hit to another part of the body
